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Characteristics of Olfactory Disorders in Relation to Major Causes of Olfactory Loss

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Characteristics of Olfactory Disorders in Relation to Major Causes of Olfactory Loss ORIGINAL ARTICLE Characteristics of Olfactory Disorders in Relation to Major Causes of Olfactory Loss Andreas F. P. Temmel, MD; Christian Quint, MD; Bettina Schickinger-Fischer, MD; Ludger Klimek, MD; Elisabeth Stoller; Thomas Hummel, MD Objective: To investigate the consequences of olfac- younger patients. Regarding changes in quality of life tory loss and explore specific questions related to the effect (QoL), we found that (1) in most patients olfactory loss of duration of olfactory loss, degree of olfactory sensi- caused food-related problems; (2) loss in QoL did not tivity, and cause of the olfactory loss. change with duration of olfactory loss; (3) younger pa- tients had more complaints than older ones, and Patients: A total of 278 consecutive patients with hy- women had more complaints than men; (4) complaint posmia or anosmia were examined. scores were higher in hyposmic patients than in anos- mic patients; and (5) self-rated depression did not re- Results: Causes of olfactory loss were categorized as late to measured olfactory function. follows: trauma (17%), upper respiratory tract infection (URI) (39%), sinonasal disease (21%), congenital anos- Conclusions: Among many complaints of olfactory loss, mia (3%), idiopathic causes (18%), or other causes the predominant ones were food related. This loss in QoL (3%). Our data suggest that (1) recovery rate was seemed to be of greater importance in younger than in higher in URI olfactory loss than in olfactory loss from older people, and women seem to be affected more other causes; (2) likelihood of recovery seemed to de- strongly than men. crease with increased duration of olfactory loss; and (3) the elderly are more prone to URI olfactory loss than Arch Otolaryngol Head Neck Surg. 2002;128:635-641 OSS OF olfactory function degree, and causes of the olfactory dis- affects the patient’s appre- order. ciation of food and drink; it has an impact on safety (eg, RESULTS detection of spoiled foods Land smoke); and it may also produce CHARACTERISTICS bodily insecurity: the patient’s own body OF PATIENTS odors are no longer self-perceived, which, in our clinical experience and A total of 278 patients were included that of others,1 has led to an exaggeration (155 women, 123 men). All of them had of patients’ hygiene measures or the olfactory dysfunction as established by excessive use of perfume. However, the means of psychophysical testing; 151 loss of olfaction can be particularly were functionally anosmic, 127 were hy- From the Department of insidious and escape detection because, posmic. Major causes for olfactory loss Otorhinolaryngology, unlike loss of sight or hearing, it is not were upper respiratory tract infection University of Vienna, Austria readily apparent to others. A good (URI) (n=102; 36%), sinonasal disease (Drs Temmel, Quint, and example of this difficulty of detection is (SND) (n=60; 21%), trauma (n=47; Schickinger-Fischer); Deutsche that patients with congenital anosmia in 17%), congenital anosmia (n=9; 3%), Klinik fu¨r Diagnostik, our population did not discover their and other causes including intoxication Wiesbaden (Dr Klimek), and the Department of olfactory loss until after age 10 years. (solvents), abuse of nasal decongestants, Otorhinolaryngology, The present study was designed to inves- Parkinson disease, radiation, or cerebral University of Dresden Medical tigate the consequences of olfactory loss infarction (n=9; 3%). No reason for ol- School, Dresden (Ms Stoller in daily life and to explore specific ques- factory loss could be identified in 51 pa- and Dr Hummel), Germany. tions related to the effect of the duration, tients (18%) (Figure 1); in at least 9 of (REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 128, JUNE 2002 WWW.ARCHOTO.COM 635 ©2002 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/30/2021 PATIENTS, MATERIALS, score between 16 and 30, he or she was considered hy- posmic. With a score lower than 16, the patient was re- AND METHODS garded as functionally anosmic.4 Olfactory evaluation re- quired approximately 30 minutes. Diagnostic criteria for the classification of the cause of the olfactory disorder are We evaluated 278 consecutive patients (155 women, 123 given in Table 1. men) with olfactory loss who were either referred or di- rectly sought help for olfactory disorders at the depart- QUESTIONNAIRE ments of otorhinolaryngology of the University of Vienna, Austria, and the University of Dresden, Germany. Sub- A self-reporting questionnaire was used that contained jects were between ages 14 and 86 years. The study was mainly questions regarding olfactory sensitivity and qual- performed according to the principles of the Declaration ity of life (QoL) issues. It had been developed in collabo- of Helsinki/Summerset West on biomedical research in- ration with the Arbeitsgemeinschaft Olfaktologie/ volving human subjects. All patients were thoroughly ex- Gustologie der Deutschen Gesellschaft fu¨ r Hals-Nasen- amined by an experienced otorhinolaryngologist, includ- Ohren Heilkunde, Kopf- und Halschirurgie, Dresden, ing detailed endoscopic investigation of the olfactory Germany. Questions related to the subjective degree of ol- cleft. Whenever a patient’s history was unclear or the psy- factory loss and associated difficulties such as cooking, eat- chophysical olfactory test results were ambiguous, the pa- ing, body hygiene, appetite, problems in everyday life, ways tient additionally underwent computed tomographic to manage this handicap, and the subjective degree of de- scans of the nasal cavity, magnetic resonance imaging crease of QoL. Both affirmative and symptom-based ques- with a special focus on important olfactory structures (eg, tions were used. Questionnaires were filled in before com- olfactory bulbs and tracts, olfactory sulcus), or olfactory mencement of olfactory tests. After receiving detailed evoked potentials.2 instructions by a member of the staff, the subjects usually completed the forms in the waiting area. CHEMOSENSORY TESTING STATISTICAL ANALYSIS Psychophysical testing was performed by means of “Snif- fin’ Sticks”3,4 bilaterally, and it involved tests for odor Statistical analyses were performed using SPSS 10.0 (SPSS threshold (N-butanol), discrimination, and identification. Inc, Chicago, Ill). Data were submitted to nonparametric Results of the 3 subtests were presented as a sum of the statistical analysis including Kruskal-Wallis, Mann- results obtained for threshold, discrimination, and identi- Whitney, and ␹2 tests. Correlational analyses were per- fication measures (TDI score).4 If the TDI score was 31 or formed using Spearman statistics. The minimum ␣ level was higher, the patient was considered normosmic; with a .05. Nonsignificant results are indicated as NS. these patients who were older than 70 years, aging sex-related differences were not significant for SND (19% might have contributed to olfactory loss.5 women vs 25% men), trauma-related olfactory loss (12% women vs 24% men), or idiopathic olfactory disorders RELATIONSHIP OF TEST SCORES (19% women vs 18% men). Approximately the same por- TO CAUSES OF OLFACTORY LOSS tion of male and female patients suffered from hypos- mia and anosmia (women, 73 with hyposmia vs 82 with Results of the 3 different olfactory tests are shown in anosmia; men, 54 with hyposmia vs 69 with anosmia). Table 2, separately for anosmic and hyposmic patients in relation to the investigated causes of olfactory loss. When RELATIONSHIP BETWEEN AGE comparing results of hyposmic patients in the 3 olfactory AND OLFACTORY DISORDER tests, we found no significant difference between the 4 ma- ␹2 Ͻ Ͼ jor causes ( 3 2.3; P .51; Kruskal-Wallis test); in other We categorized subjects into 3 age groups: group A, words, the results pattern from the 3 olfactory tests did younger than 41 years (n=60); group B, 41-60 years not indicate the cause of the disorder. (n=130); and group C, older than 60 years (n=88). Dif- In URI olfactory loss, more patients were found to be ferent causes were present at different ratios in these 3 age hyposmic (n=62) than anosmic (n=40) (␹2=4.75; P=.03). groups. The highest percentage of URI olfactory disor- In contrast, for all other causes, this ratio was reversed (for ders was seen in older subjects (group A, 23%; group B, SND, 28 hyposmic vs 32 anosmic [NS]; trauma, 15 hypos- 31%; and group C, 55%). No such differences were found mic vs 32 anosmic [␹2 = 6.15; P = .01]; idiopathic cases, 18 for SND (A, 30%; B, 24%; and C, 13%), posttraumatic hyposmic vs 33 anosmic [␹2 = 4.41; P= .04]; other causes, causes (A, 20%; B, 18%; and C, 14%), or idiopathic causes 4 hyposmic vs 5 anosmic [NS]). (group A, 15%; B, 22%; and C, 15%) (Figure 2). Statis- tical differences in the relative presence of the 4 most fre- RELATIONSHIP BETWEEN SEX quent causes were found only for group C (␹2=46.38; AND OLFACTORY DISORDER PϽ.001). The relative number of hyposmic patients was not significantly different in different age groups (group A higher percentage of women (44%) than men (28%) A, 31 hyposmic vs 29 anosmic; group B, 56 hyposmic vs suffered from URI olfactory loss (␹2=11.3; P=.001). These 74 anosmic; group C, 40 hyposmic vs 48 anosmic). (REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 128, JUNE 2002 WWW.ARCHOTO.COM 636 ©2002 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/30/2021 Table 1. Categorization of Patients According to History of Their Olfactory Disturbance* Cause of No. of Olfactory Loss Patients History Olfactory Cleft† Onset Post-URI 102 Prior symptoms of upper respiratory tract inflammation Patent Sudden Posttraumatic 47 Prior head injury, closed or open Patent Sudden SND 60 Chronic rhinitis or sinusitis, anatomical obstruction Patent or obstructed Gradual, fluctuating Idiopathic 51 None of the above Patent Sudden or gradual Congenital 9 Never experienced any odorous sensations Patent Olfactory sensations never present *URI indicates upper respiratory tract infection; SND, sinonasal disease.
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